S3E14: Bridging Cultures in Medicine

Margaux: Did you get it for free? Is this part of your free scavenging? It's fancy.

Celessta: I know my friends and I started this. All we did . . . have you heard of ClassPass?

Margaux: Yeah. You started it?

Celessta: Yeah.

Margaux: Awesome.

Celessta: It's really awesome.

Chloe: Are we good?

Celessta: Sorry.

Margaux: Yeah.

Chloe: Are we done chewing?

Margaux: She always does this right before we start.

Harjit: I'm sorry. I'm kind of a mess.

Chloe: She always has to chew right before we start recording.

Margaux: Hey, everyone. Welcome to "Bundle of Hers." Margaux and Harjit in the studio today.

Harjit: Hello.

Margaux: We have Leen also listening, but today we have a very special guest, Celessta Merrill.

Harjit: Merrill.

Celessta: Merrill, yes.

Harjit: I have a teacher named Mrs. Merrill.

Margaux: I want to be so conscientious about names, and then I say it in my head, say it in my head.

Harjit: I know. And then you forget it.

Margaux: And then when it finally comes time to say it, I get so nervous that I'm going to butcher it, and then I do. So that's all in my head.

Celessta reached out to us on one of our posts about a book called "The Scalpel and the Silver Bear," which is about the first Native American woman surgeon, her autobiography. And Celessta kind of told us a little bit about her story related to that book. So we thought it was so great, we wanted to share with you her story and her life as an NP with you all, since we haven't talked about that part of healthcare yet. NP meaning nurse practitioner.

So, Celessta, welcome to "Bundle of Hers."

Celessta: Hi.

Margaux: Thank you for joining us.

Celessta: Of course.

Margaux: Would you mind sharing with the audience a little bit about your identities and who you are and what you do?

Celessta: Yes. So my name is Celessta Merrill. I am a Navajo female. I grew up on the reservation my entire life. I moved after high school to get off the reservation to try to see what life is off the reservation, to expand my own knowledge and education. And I've been living here in Utah now for over 15 years.

I started my educational career and went into nursing. Started that, completed nursing school, and I decided that I wanted to further my education even more than floor nursing. And I really wasn't wanting to specialize in nursing. I just wanted to keep my learning very broad.

I applied to NP school just to see if I could even get in or would get accepted. But that's all I wanted to know for myself, knowing likely I'm smart enough and I can do this, but let me just test it and see. So then I applied to NP school and I got in.

Margaux: Awesome.

Celessta: And I when I got in, I'm like, "Okay, do I really want to do this? Because now I have to actually do the process and go through school and be in grad school." And that was a little scary for me. Then I didn't know if I would be smart enough to complete it. So I'm like, "Well, let me just give it a try and just do my first semester and see how that goes." And that just jump-started everything.

I did very well and graduated just this past May, so I'm pretty new in my career, in my role, but I've been learning a lot. I still go home and visit. I grew up in the Four Corners area down in New Mexico in a little town called Hogback, New Mexico. It's near Shiprock, New Mexico. I just tell everyone that I'm from Shiprock, New Mexico, because Hogback is not even on a map.

Margaux: Oh, wow.

Celessta: Yeah. So I'm from Hogback, New Mexico, and that's where the rest of my family is.

Margaux: Initially, you said you are a Navajo woman. And something I'd like to define and bring up for our listeners is that I've heard a lot of different terms.

So first of all, I think it's very important that we all recognize there are very different tribes in the United States, and each of them has their own identities and own cultures and deserve to be recognized as their own groups.

But there are these umbrella terms that are different that we see in the media, and that being Indian or Native American or American Indian or indigenous. Do you prefer any of those, or is there one that should be used over another?

Celessta: Just generally, Native Americans is the preferred term. But within the Native American culture, that's when they start to really define the tribes, because each tribe wants to be identified as their tribe. So, generally, I would just be Native American. But if we were among other Native Americans, it'd be like, "I'm Navajo." And then just kind of differentiate from there.

Margaux: And I think that's really important. I think people tend to have these umbrella terms, like Native American, to represent all of the different tribes, and like you just said, they each have their own cultures. The conversation needs to shift to actually talk about each culture and each tribe and what their needs are in terms of being very underrepresented, in this case, in medicine, and how the different barriers for each tribe and each member of the tribe face into getting into medicine if that's what they want to do.

Celessta: Yes. And I think the term Indian, as well . . . Indian, there are two different types. So I think that just causes some confusion. And I think that's why the Native American term is just a little bit better.

Margaux: Thank you for sharing that with us. So you talked a little bit about how, after high school, you wanted to get off the reservation, and so you came up and got into nursing school. Was there anything that drove you specifically to go into healthcare versus business or chemistry or something else?

Celessta: Yes, two reasons. One reason was when I was little, my brother and my dad had gotten into a motorcycle accident. So my brother was a little more critical than my father, so he was flown to Albuquerque, New Mexico, into their critical care unit. I don't know how old I was. I was still pretty little. But I remember being there at the hospital, and we didn't leave his side. My mom and my sister, we stayed in his room with him the entire time.

And I have this image of him lying in the bed, and he had this huge incision that was on his left thigh. And I remember the nurses coming in to do dressing changes on those all the time, and I was really fascinated by that. Just the different things that I observed during his hospital stay, that's what sparked my interest in healthcare. And I was like, "I want to do that someday."

My interest started to grow more when my aunt was in the hospital, and she was in a hospital because she was diagnosed with cirrhosis of the liver from alcohol. Her nurse was . . . it was a different observation than I had experienced compared to my brother's. It was a little bit more negative, uncompassionate, and she was just a little bit harsher and judgmental. It just kind of caught me off guard.

I'm like, "Well, my auntie here is dying, but she's got this nurse with her who . . ." For me, I figured it was because of the stigma on Native Americans. Yes, there are issues with alcoholism, but I kind of felt like her impression on Native Americans and working on the reservation . . . she was a female white woman, so I wasn't sure if it was just something she saw all the time.

But seeing that, I really was interested in nursing and wanted to be one of those nurses who was never judgmental and who was compassionate. And I knew, "Okay, if I ever have a patient like my aunt, I know how to handle the families. I know how painful it is personally, and it would be easier for me to connect."

And I just wanted to kind of change . . . I mean, there's so much to change in nursing, but just to be even that little change in nursing, I would be the one responsible for teaching and educating new nurses coming on.

Margaux: Very cool.

Harjit: Yeah, that's really cool. I think it takes a lot of courage to come to a whole new place. I think, historically, there's a lot of trauma. I find it beautiful that you were able to take this journey, but I also imagine it was very, very difficult.

Celessta: It was very difficult having to leave, knowing that that reservation, that's where my entire family is. So that was my safe space. I was comfortable there. And really, no one ever leaves the reservation, or they try to and attempt to, but they always go back because it gets too hard.

For me, it was terrifying. When I first moved up here, I moved up with a group of friends just to get off the reservation, just to see if I could pull myself away and try to support my own self, and to maybe just change the cycle back home.

I did end up staying. I didn't start school for a little while because I didn't know that process, how to apply for college, because that really wasn't taught to us. So I had to figure that out on my own, and that was very difficult. And then knowing, "Oh, there's all this tuition that you have to pay for." I'm like, "How am I going to pay for that?" Just learning all of that on my own was a little difficult.

But what did keep me away and what was motivating for me was my own childhood and the way I grew up. So like I mentioned before, alcoholism is a big issue on the reservation. It is getting better, but I grew up in a home with . . . both my parents are alcoholics.

So we grew up in a very small, two-bedroom mobile home. My two sisters and I all shared one room. My brother, for as long as I remember, has never had his own room. His bed was our living room couch. So that's where he stayed all the way through adulthood.

And I decided, after just seeing the alcohol and the abuse, that I don't want that for my life. I need to change something, and I wanted to change that cycle not only for me but, at the time, for my siblings. I wanted to try to eventually get off and maybe get a career and get a job so I can help them move and get off the reservation, as well. That was my motivation at the beginning.

So when I started school, my dad actually got really sick. He was diagnosed with cirrhosis, and it got pretty bad. He died the summer I started nursing school. So that was really traumatic for me, and it was really difficult to even complete that first semester of nursing school after, you know, the grieving and all of that. I wasn't very determined to really try to create a change.

I have a daughter. She's 12 years old. So she started to become my motivation. I mean, she did see some of that, because we go home and visit. So then I wanted to be that role model for her. Not only for her, but it is kind of sad when I do go home and I do visit and I see my cousins or my nieces and nephews struggle with their lifestyles, and just being at home and seeing all of that.

A lot of them will tell me that it's not possible for them to leave because they don't have the support. They don't have the finances. But I have to sit and talk with them and just remind them, "There's really no excuse for you not to at least try. You've got to have some type of determination and motivation to get going. And as soon as you do get going, it just starts to build and build."

And then for those kids who have grown up in my same situation, I want to be that hope for them, just so they can see that it is possible. Go back and talk to the schools on a reservation and tell my story and just give the kids, teenagers, young adults some hope for their future.

Margaux: You had and have such a beautiful power inside you that helped drive you forward, which I admire a lot. And I think you are a very strong voice and image for those people in your community.

But it is very difficult to sit down and talk with someone who feels so oppressed. And like you said, you didn't even know how to apply to college. And so, to someone who may not have as much power or ability to get up and get moving like you did, it can be so hard to see the next step. I think it's so great that you're there to tell them.

But I think that's the other important thing in having conversations and sharing stories like yours, is the more we talk about it, the more we understand what the problems are. Even just how do you apply to college? Where do you go? How much is tuition and how do you get scholarships? You moved up here with some friends, and I think that support system can be super helpful in navigating a situation like that.

So thank you for sharing all of that. That's such a beautiful story.

Harjit: Yeah, and I think I really resonated with the concept of breaking the cycle. It's something that I always talk about. I also am a first generation student, and I think that me and my sisters, we always realized that we couldn't survive our conditions the way they were. I kind of really resonate with you, because our motivation becomes that we can't survive this.

Celessta: Exactly.

Harjit: It's not even an option anymore.

Celessta: It's like you have to do it.

Harjit: Yeah, you have to do it. Otherwise you can't see yourself living the same life, right?

Celessta: Exactly.

Harjit: I think that becomes a really, really big motivation for people who kind of get out. And I think it's beautiful that you recognize that and also that you are intentional with the work that you do now because of it.

Margaux: And something else that you talked about is the nurse, the negative experience you had with your aunt, the nurse who was taking care of your aunt, sort of motivated you to want to be a different kind of nurse that took care of patients very differently. When you have patients who are Navajo, how is that interaction? What is that like, and how do you think that makes them as a patient feel compared to having . . .

Celessta: I mean, inpatient, I've only had, being at the VA, one Navajo patient.

Margaux: Oh, okay.

Celessta: And that was it. But I see them around the VA. Even now as a nurse practitioner working outpatient, I don't have any patients who are Navajo or from other tribes.

But the one patient that I did have who was Navajo, at first, because I have not been down on the reservation or have lived there for a very long time, it was a little intimidating to go into his room and introduce myself knowing that he was Navajo, and him seeing me and knowing that I was Navajo.

So Navajos are really funny when they see each other or meet each other. They will make eye contact, but really won't engage in a conversation unless someone starts the conversation. So you could just walk by each other and kind of look at each other, and maybe just wave or smile, but really not speak to each other, which is really silly. I mean, I think that could change.

That in myself has been another thing that I've had to work through. I've had to learn how to speak out more. So now, when I see other Navajos or Native Americans, I'll go and say, "Hey. Hi. Where are you from?" or, "What tribe are you from? What are your clans?" Because our clans is another identification of relationships. So it's like how we are related.

And that's what I asked this patient. So I was like, "Hey, you're Navajo. Where did you grow up? What area? What are your clans?" And through that, we were able to identify that we are related by our grandparents. So I'm like, "Oh, we are actually related." We don't know each other, but we have that connection.

So then talking with him and having that little connection made, I guess, our relationship as his nurse and my patient . . . it was really good. I was able to help them through some things and talk through some things within our culture with him that he was struggling with living here in Utah that people around him did not understand. So that was really helpful for him to just talk about his tribe and all the struggles he was going through.

Margaux: Yeah, I think that's so important in having healthcare providers with very different backgrounds be able to connect with patients with different backgrounds, whereas another provider may not have even known to ask any of those questions about his life or even have felt comfortable confiding that with another provider.

It's so beautiful to have amongst our coworkers different experiences to share, like the story that you just told me, so that I can take forward that knowledge and know there are so many things about a patient from a different background other than mine that are so hidden and that need to be understood, too.

Celessta: There is. And I remember also having this other patient not at the VA. I used to work in rehab nursing for a little while, and I had this female Navajo patient, and she was in the rehab room. They had shared rooms, and her roommate had gotten really sick, and she had died in that room.

So for a couple days after that, this female patient was really upset. The nurses and everyone did not understand why. They kept trying to talk to her. She didn't want to talk to anyone. So the nurse was like, "I don't get it. I don't know why she was fine for the longest time, and all of a sudden, now she's just really upset. She's mad. She's angry."

I'm like, "What happened?" Then when she told me the story, like, "Well, her roommate, this had happened. She had died." I'm like, "Oh, that is really bad. You've got to get her out of that room." And like, "Well, what if we put someone else in there?" I'm like, "No, she's got to be out of that room."

I said, "If a death happens, in our culture, that room that the death happened in is kind of like taboo, I guess. Now it's like that room, we cannot go into." So I said, "You just need to pull her out of that room and put her into a different room."

But they didn't get that. I mean, they wouldn't understand if they're not from that culture. But she wasn't talking also, and it just made it a very complicated situation.

Margaux: Yeah. And again, it's so valuable to have all those different experiences where even if you as a provider are not from that same background can come and talk, or have talked, or even read in a book about the different cultural . . . and just think, "Maybe there's something else going on that I don't understand," and have that humility to know that you're probably missing something and go and find an answer.

Like you said, it was just a simple solution to move the patient to a different room, one that will greatly increase the value of their care, and yet it just comes from finding a simple solution and understanding that person's culture and needs in that way.

Harjit: So we talked a lot about things that you noticed because you're a part of a community, and something that you feel like you could have picked up on that maybe other people didn't understand. What are kind of the bigger things that you focus on when it comes to native health?

You've said that you want to be a part of this healthcare field because you want to in a small way make a change by being there for a patient, right? Because you saw these experiences, you don't want anyone else to feel that way, so you wanted to be a part of that. Is that kind of your biggest focus in coming into healthcare, or was there this other larger thing that you wanted to work on?

Celessta: It was my focus coming into healthcare, but as I started to grow in my education and my career, that started to change. So, right now, I am hoping when I am done with this residency program at the VA . . . I was considering staying at the VA, because I do love our vets. Our vets are amazing to work with. But I also have this other opportunity where I do want to go and apply and work for the Indian Health Services.

I want to just be involved in . . . it doesn't have to be my own culture, but just any culture, any Native American culture. Just to have someone who is Native American and a nurse practitioner be their provider, to have that connection could potentially go a long ways with their own healthcare, just to help them understand.

A lot of the times, they just don't understand or they just don't want to hear what . . . for example, if their provider is a white person, they're like, "Well, I don't want to listen to what that white person has to tell me."

Harjit: Because there's a lot of distrust, right?

Celessta: There is a lot of distrust.

Harjit: Which is justified based on all the stuff that . . .

Margaux: Their historical trauma.

Harjit: Yes.

Celessta: Yeah, so then they are not compliant with their medications. I mean, I always see noncompliance with diabetes and hypertension and all of that, but I don't know if it's just because they don't want to do . . . They don't want to be told what to do by a provider that's not within their own culture, and I think that is the barrier, as well. So me being a Native American, I don't know if it will make a difference, but I would like to go and try and to work and see.

Harjit: I'm sure it will. And also, again, from an outside perspective, I've known the native people to be very into wellness and health culturally. Just what I know, the little amount I know, I think that that has always existed. I think culturally, from the beginning, health and healing have been very important, right? Integral.

Celessta: Oh, yes.

Harjit: I always thought that was interesting. But in medicine and in healthcare, in ways there are stereotypes and judgments that they don't take their medications.

Celessta: Yes, exactly.

Harjit: There's a lot of alcoholism. You know, there are a lot of stereotypes that come just seeing a person that is Native actually have that "power" that . . .

Celessta: Connection, I guess.

Harjit: Connection, yeah. It allows them to maybe have that comfort.

Celessta: Yes.

Harjit: There's someone on my side, and there's no hidden meaning or message for them wanting to help me.

Celessta: Exactly. And like the book that you guys read, kind of like bridging Western medicine with their culture and trying to find a middle ground and say, "Okay, well, let's try this, but you can also do this as well." And just trying to figure that out for them.

Margaux: And I think another cool thing that will happen when you're the provider in the Native American community is like when your brother was sick and you had that experience in the healthcare system and that inspired you, another child who also is going to the doctor with their mom or their grandma and sees you as a provider then has a connection and an easier time to get in and talk to you about your journey into healthcare and what the steps may look like for them.

And so, maybe then it's one less barrier down or five less barriers down. I think that will be an awesome way to connect, too.

Celessta: Oh, yeah, definitely. That's one of my goals, is to go down and just to be that face and to be a role model for the younger generations. Just to see me in practice doing that, knowing how I grew up and where I came from and the challenges in life that I had to face growing up.

Margaux: You've shared a lot about your whole journey, which I think there are a lot of tones of you having this initiation to go forward and push through the barriers and the walls and the unknown and being very vulnerable. Where do you find that inspiration and that courage to push through, and what's a message you would leave for all of our listeners to find and share that same strength?

Celessta: I mean, my dad is a big part of my life, and that is where a lot of my power comes from. He may not be here, but I still want to make him proud. Sometimes it's still so hard to talk about him.

Margaux: Of course.

Celessta: It's so emotional. But really, that's where a lot of my power comes from, is just him, my family. Yeah.

Margaux: I love that.

Harjit: I think that's so beautiful. Celessta, I think that you talked a lot about breaking the cycle, and I think you've already broken it, and I think that's such a powerful thing that you've done. I just want to really respect the power that you are as a person for sharing your stories with us, because I think they're so important.

Native American voices are some of the most missing voices in any conversation, right? Thank you for letting us know a little bit more about you and who you are and the power you carry within yourself.

Celessta: No problem. Thank you for inviting me.

Harjit: I think it takes a lot of courage to do what you did, live the life that you've led. I always say this, but it doesn't end. We still have a lot of barriers every single day.

Celessta: Oh, yeah, definitely.

Harjit: And just going through them and surviving even another day is beautiful.

Celessta: I agree.

Harjit: And then maybe we can do this again, because I did it with Leen on a different episode, but I just want to respect the land we're doing this podcast on, which is the Eastern Shoshone land, and thank basically the land and the people of the land.

Margaux: Yes. Thank you again, Celessta. We're so honored and I was so grateful to hear your story. Thank you to our listeners for all your support. If you have anything you'd like to add or if you have a story to share with us, you can continue the conversation on Instagram at Bundle of Hers or on Facebook at Bundle of Hers Podcast. We'd love to hear from you. Also, stay tuned for other episodes, and thanks for listening. Bye.

Harjit: Bye-bye. I can't say it.